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pediatric
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TEF Repair — Neonatal Anesthesia for Tracheoesophageal Fistula
Open thoracotomy, fistula ligation, and esophageal anastomosis in the newborn with esophageal atresia
TEF repair is an open right thoracotomy in a newborn with esophageal atresia (most commonly Type 3b/Type C with a distal tracheoesophageal fistula); the airway, the fistula, and the gastric distension it can produce are the three anesthetic problems that define the case.
If you forget
IF YOU FORGET — TEF REPAIR
Board trap
Question: 'You mask-ventilate the baby before intubation — what just happened?' The trap is gastric distension through the distal fistula, which can rupture the stomach, splint the diaphragm, and make ventilation impossible. Suction the upper pouch, minimize bag pressure, and have the surgeon gastrostomize emergently if the belly blows up.
Key numbers
- ≥ 5 new EA patients per year — minimum caseload defining an ERNICA 'specialised centre' (consensus item 27).
- ≤ 4 days post-op — window when chest-tube/pleural drainage prompts surgical re-exploration.
- 100% — Rigid tracheoscopy is mandated at the START of surgery to exclude an upper fistula or other malformations (ERNICA).
- Antenatal EA suspicion (ERNICA item 26) → referral for multidisciplinary specialized-centre counselling.
Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ERNICA EA TEF Surgical Management 2022 · ERNICA EA TEF Surgical Management 2022 · ERNICA EA TEF Surgical Management 2022
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: tef-repair · Path: aba.pediatric.neonatal-and-infant-surgery.tef-repair